Director Revenue Cycle

Position Description

This position directs all operational and strategic leadership functions related to the entire Revenue Department and all centralized revenue cycle functions in a multi-disciplinary, multi-specialty medical clinic setting. They oversee the teams and departments that manage accounts, communications with payor sources, collections, contract analysis, cash posting, billing transactions with clients, medical records and report creation: namely the patient collections, coding, insurance verification, insurance collections, medical records, liens, and accounts receivable departments within the Revenue Department. They implement quality control standards and audits to ensure that all coding is properly billed under the industry guidelines as set by the AAPC.

Position Duties

The position requires the following primary duties to be successful:

• Directing the multiple components of the revenue cycle include pre-authorization, eligibility and benefits verification, claims submission, payments and payment posting, claims denial management, reporting, and any other functions which involve patient revenue management.
• Supervising the Coding and Charges Department in various duties, such as medical documentation review, proper CPT and ICD-10 documentation and entry, timely entry of all charges, and performing of quality control audits
• Implementing and directing a system to ensure that accurate billing information is entered into the billing system
• Setting and meeting collections goals by department and for the organization overall by directing the collection processes for individual patients, attorneys, and insurance companies.
• Directing staff performance by providing regular feedback, performance reviews, and one-on-one meetings
• Overseeing the hiring and training of staff
• Attendees monthly and/or quarterly AAPC seminars to assure all coding is aligned with the industry standard and changes
• Planning and structuring the department workflow and staffing
• Correctly coding diagnoses and procedures
• Ensuring proper timely filing of all claims by implementing a timely standard of charge entry
• Annually reviewing and updating of charge master
• Negotiating contracts with insurance companies
• Collaborates professionally with clinical staff and all other departments to maintain unity and successful resolve outstanding request
• Keeping updated records and tracking reports as required by management
• Insuring proper filing of liens
• Other duties as requested of the Revenue Cycle Director that are consistent with and appropriate for this position title and role.

Position Expectations

To perform the position successfully, an individual is expected to:

• Provide proven experience as a manager of correct coding and documentation in the healthcare industry
• Demonstrable experience with coding and charge entry
• Knowledge of AAPC guidelines and industry correct coding standards
• Sound knowledge of healthcare billing rules & regulations
• Working knowledge of MS Office & Excel
• Excellent communication and interpersonal skills
• The ability to negotiate and interact regularly with both insurance companies and attorneys
• A strong analytical mindset
• Outstanding organizational skills
• Be passionate and professional
• Be success-driven and metrics focused
• Be smart; work smart
• Have a positive attitude
• Leadership by example
• Be a positive agent for change/improvements within their department
• Have a thorough understanding of the operations and the technology behind revenue cycle management.

Position Metrics

The execution of the position is quantifiably measured by the following:

• Establishing, managing, and meeting department goals
• Maintains quality control standards for the department through documented quality control audits
• Supports the successful attainment of the global revenue goal

Position Requirements

• Minimum Education Level: Bachelor’s degree in finance, Accounting, Healthcare Administration, or a related field.
• Revenue cycle certification preferred.
• Minimum of 5-7 years of experience in revenue cycle directorship, preferably in a multi-specialty medical clinic or similar setting.
• Proven experience in a leadership role directing a revenue cycle team, as well as direct operational experience in all phases of medical revenue cycle
• MS Office & Excel experience
• Experience with EHR and PM software, specifically NextGen platform preferred.
• Preferred: Ability to multi-task under time pressure. Strong communication and leadership skills
• Be team oriented and able to work with various departments. Be able to make sound decisions while on the move in a fast-paced organization.